1. For outpatient and inpatient treatment, the insured person must show his social security card and swipe his card for medical treatment. The outpatient department must inform the hospital of the treatment category (such as chronic disease and outpatient service). If the card card is not produced or the treatment category is not clear, the medical expenses incurred by the insured employees when they seek medical treatment will not be paid by the medical insurance fund;
2, the insured in the designated retail pharmacies to buy drugs, must show my citizen card, inform the treatment category (such as outpatient chronic diseases, special), according to the relevant policies to buy drugs, because of special circumstances by others purchasing drugs, must show the insured and the purchaser's identity card, and registered by the pharmacy;
3, outpatient co-ordinate the implementation of the first diagnosis and referral system based on community health service institutions. Insured persons can be first diagnosed or referred to community-managed medical institutions in designated community health service institutions for urban workers' basic medical insurance; Specialized hospitals can be used as the first medical institutions for all insured persons. If the insured person needs a referral, the first-visit medical institution shall be responsible for the referral, and emergency rescue is not subject to this restriction. After the outpatient chronic disease subsidy limit is used up, you can directly enjoy the outpatient co-ordination treatment from the next cost, without referring to the original chronic disease. After the subsidy limit for specific outpatient items is used up, referral procedures must be handled according to the provisions of outpatient co-ordination, and ordinary medical records can be used to enjoy outpatient co-ordination treatment. Buying medicine in a pharmacy does not enjoy the overall treatment of outpatient service.
The scope of medical insurance reimbursement includes:
1, medical expenses during rescue;
2. Medical expenses during hospitalization;
3, surgical materials and AIDS;
4. Bed fee: according to local medical insurance standards. Except those who need to stay in ICU (intensive care unit) because of acute craniocerebral injury and complex visceral injury coma, but they should be transferred to the general ward immediately after they are out of danger;
5. Rehabilitation physiotherapy fee: according to local medical insurance standards. In principle, there are no more than three kinds, and rehabilitation physiotherapy outside the scope of medical insurance will not be compensated;
6, dressing change and rehabilitation function guidance training: according to local medical insurance standards combined with disease needs;
7. Ambulance fee: calculated according to the standard approved by local health department and price department;
8. Other expenses: expenses that are not compensated according to regulations will not be compensated;
9. Continuing medical expenses: In order to close the case in advance, the insured can pay the necessary continuing medical expenses for the injured in the future in advance. Only when the discharge certificate or diagnosis certificate clearly indicates that the competent doctor needs to continue treatment, or the internal fixator is removed after half a year or one year, or the follow-up treatment expenses are reviewed or recorded regularly, and the compensation payment voucher provided by the insurance record for the follow-up expenses can be reviewed. According to the needs of the disease, obviously beyond the needs of the disease, the audit fee for continuing medical treatment will not be compensated.
To sum up, bring all the necessary information to the relevant departments of the local social security center. Upon examination, if the information is complete and meets the requirements, it will be handled immediately. When applying for reimbursement of outpatient medical expenses, the applicant should first deduct the amount allocated to the personal account of medical insurance in this social security year, and then verify the amount to be reimbursed.
Legal basis:
Article 12 of the Social Insurance Law of People's Republic of China (PRC)
The employing unit shall pay the basic old-age insurance premium according to the proportion of the total wages of its employees stipulated by the state, and record it in the basic old-age insurance pooling fund. Employees shall pay the basic old-age insurance premium in accordance with the proportion of wages stipulated by the state and record it in their personal accounts. Individual industrial and commercial households without employees, part-time employees who have not participated in the basic old-age insurance in the employing unit and other flexible employees who have participated in the basic old-age insurance shall pay the basic old-age insurance premiums in accordance with state regulations and record them in the basic old-age insurance pooling fund and individual accounts respectively.